"It took me on a journey other than just to stop smoking": Pilot trial outcomes of an Empowerment Theory-based smoking cessation intervention for sexual and/or gender minoritized people in Oklahoma.

Introduction: Sexual and/or gender minoritized (SGM) people are more likely to smoke if they live where SGM stigma is high, and existing SGM-tailored cessation interventions do not address unique challenges of these environments. This paper reports outcomes from a single-arm pilot trial of an Empowerment Theory-based smoking cessation intervention for SGM people living in high-stigma environments.

Methods: SGM adults willing to quit smoking (N=20; Oklahoma) participated in a 12-week intervention comprised of online SGM-serving volunteer activity sessions concurrent with remotely-delivered smoking cessation support (i.e., behavioral support plus combination nicotine replacement therapy [NRT]). Baseline and exit surveys and in-depth exit interviews addressed retention, acceptability, engagement, and adherence.

Results: Study retention was 80.0% (16/20). Most exit survey respondents attended ≥4 volunteer activity sessions (62.5%; 10/16) and ≥4 cessation counseling sessions (87.5%; 14/16), had moderate/high NRT adherence (patch 84.6%; 11/13 and gum/lozenge 76.9%; 10/13), and would recommend the intervention (81.3%; 13/16). At exit, 7-day point prevalence abstinence was self-reported by 45.0% (9/20; missing=smoking) of all participants and 56.3% (9/16) of exit survey respondents. At least half of participants reported pre-post intervention increases in perceived assertiveness and/or decreases in sexual identity acceptance concerns, concealment concerns, and internalized transphobia. Interviews identified intervention endorsement reasons, including experiencing greater belonging and hope.

Conclusion: A novel approach to SGM-tailored smoking cessation treatment that leveraged Empowerment Theory was feasible and acceptable. Future work should refine and adapt this intervention for other high-stigma places, test its efficacy and treatment mechanisms, and measure organizational and individual-level outcomes.

Implications: This study adds to the literature on culturally tailored smoking cessation interventions as the first tobacco intervention tailored for SGM people in high-stigma environments. It used a novel application of Empowerment Theory to advance SGM smoking cessation and resilience in the face of minority stress. Findings from this pilot study in Oklahoma indicate promising feasibility and acceptability and will inform future interventions to address tobacco use disparities among SGM people in high-stigma environments.